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BUILDING PERMIT APPLICATION TIGARD DATE____
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FORTH E WORK HEREIN INDICATED BUILDER PHONE _
OR AS f,HOWN AND APPROVED IN THE ACCOMPANYING PLANS ANP SPEC IFICATIOWS OWNER PHONE _-
LOT NO. _-- --
OWNER of CPQB,AiDDRESS .$•+ "' _-_._--------- - --_
ARCHITECT
ENGINEER
BUILDER q 1,11re ADDRESS _-_._ -_DESIGNER —_-- - —
STRUCTUaE ❑ NEW ® REMODEL ❑ ADDITION ❑ REPAIR ❑ RENEWAL L, FIRE DAMAGE ❑ DEMOLITION
❑ RESIDENCE CC COMM ❑ EDUCATIONAL ❑ GOV'T 0 RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE CJ SLAB FENCE
OCCUPANCY LAND USE ZONE BLDG.TYPE ` --FIRE ZONE___PLAN CHECK BY ,___=HEAT-—___-
1 1 t�xjst;irrt Aaragcw
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z i 'r�Ou 114it of r,,�j nrres and --
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SEWER PERMIT M --- - ---
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA NO.BEDROOMS VALUE
BUILDING DEPARTMENT — SETBACKS FRONT REAR LEFT SIDE RIGHT SID
-- ---------
Permit _ -- 4 __ THIS PERMIT IS ISSUED SUBJECT TO THE REGULAT'ONS CONTAINED IN THE BUILDING CODE. ZONING
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS t'ERFBY AGREED THAT THE
Plan Check + WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIDNS AND IN COMPLIANCE
WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
Sub-total RESTRICTIVE COVENANTS-CONTRACTDR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
LICENSE.SEPARATE PERMITS REQUIRED FOR SEWER,PLUMBING AND HEATING.
State Tax
-- —
SDC-- I
Total t 1.41' • -
-- PDC# APP�LIICANT OR AGENT
By Receipt No. �1f b � �.� E
1
Approved
bC' PHONE
DATE INSP.1 I :r.::'=o?ECTION REMARKS PLUMBING DATE--
-Ac ` — Contractor —_ _—
' Permit No.
091-4
Fin --
HEATING
Contractor
4n,1V 4V Permit No.
Got or Oil
Rough-in
Final
SEWER -
- ------ — Final
--- — ---- DRIVEWAY --- —
Final
Storm Drainage
— --�—� -- ------
(Rain Drain)Final
— --- `- •— Sidewrlk
Curb&Street Final
Approach
BLDG. DEFT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY 2/to'7/ ' — —
1 p Landscaping
7/a Zoning Find
1
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